DIAGNOSTIC-VALUE OF LIVER-BIOPSY IN SYMPTOMATIC HIV-1-INFECTED PATIENTS

Objective: To evaluate the diagnostic value and risk of liver biopsy i n symptomatic human immunodeficiency virus (HIV) infected individuals with hepatomegaly and/or abnormal liver function tests. Methods and pa tients: Retrospective analysis of 25 consecutive HIV-infected patients undergoing liver biopsy with respect to indication, use of medication , diagnostic yield and complications in the period 1984-1989 in an aca demic hospital, drawn from a population of 550 HIV-infected persons un der care during the study period. Results: In 18 patients (72%), liver biopsy was explanatory for the underlying liver disease. Histopatholo gic features compatible with drug-induced liver disease was found in n ine patients (36%). In four others, mycobacterial infection was diagno sed, in one cytomegalovirus infection, in another acute hepatitis C an d in another histoplasmosis. Two patients (8%) died as a direct conseq uence of the biopsy. Pattern of liver function test did not predict hi stopathologic diagnosis. Conclusion: Liver biopsy makes an important c ontribution to the understanding of underlying liver pathology in symp tomatic HIV-infected patients and is the fastest method for diagnosis of viral or mycobacterial liver involvement. Drug-induced liver injury was unexpectedly common. Risks are considerable, however, necessitati ng careful consideration of indication.